Comparative Analysis of Preadmission Testing Center and Primary Care Physician Clearance Before Total Joint Arthroplasty

Background Effective preoperative evaluation is crucial for mitigating complications and cancellations in total joint arthroplasty. Limited access to a primary care physician (PCP) and fragmented coordination can delay clearance and increase perioperative risk. To address these challenges, preadmission testing centers (PATCs) have been implemented to streamline workflows. This study compares outcomes and cancellation rates between PATC and PCP-led pathways. Methods Retrospective study of patients undergoing total joint arthroplasty between June 2022 and November 2024 at 2 community hospitals comparing demographics, outcomes, and cancellation rates between PATC vs PCP. Statistical analyses included sample t -tests, Mann-Whitney U tests, chi-square, or Fisher's exact tests. Clinical outcomes including length of stay, discharge disposition, complications, and cancellations were adjusted for age, body mass index, and Charlson Comorbidity Index. Results Among 8784 patients, 5641 (64.2%) were evaluated at PATC and 3143 (35.8%) by PCP. Patients evaluated at PATC were younger (68.98 ± 9.35 vs 70.38 ± 9.01 years, P < .001) and had a higher Charlson Comorbidity Index (median 1.0 [2.0] vs 1.0 [1.0], P < .001). Overall cancellation rates ( P = .637) and 90-day postoperative complications ( P = .212) were similar between groups. However, the PATC group demonstrated a slightly longer length of stay (median 27.9 [5.3] vs 27.5 [5.0] hours, P = .001), higher discharge to skilled nursing facilities (4.0% vs 2.3%, P < .05 after Bonferroni adjustment), and greater postoperative emergency department utilization (6.6% vs 4.0%, P < .001). Conclusions Despite managing a higher-risk population, PATC evaluation demonstrated comparable cancellation and complication rates to PCP clearance, supporting centralized, protocol-driven preoperative evaluation as a viable alternative in real-world settings where access to primary care may be limited.